Background Child maltreatment is a public health problem of global magnitude. This thesis examined different aspects of the multi-sector response to child maltreatment in Sweden and in Europe.

Aims To explore how child physical abuse (CPA) is disclosed and how adolescents perceive adult support when they report physical abuse. To examine how police-reported cases of suspected CPA were associated with criminal investigation procedures and prosecutions. To assess how physicians who care for maltreated children across Europe are organised to recognise and respond to child abuse and neglect. To investigate time trends in rates of childhood deaths in Sweden recorded as due to external, ill-defined and unknown causes, from 2000 to 2014.

Methods We analysed data from a school-based national survey of adolescents, police records of reported suspected CPA in a metropolitan area, a purposeful survey of European child abuse physicians and individual-level data from the Swedish cause of death register. We used quantitative methods to calculate prevalence, descriptive statistics, odds ratios, logistic regression and trends in mortality rates. Qualitative methods included content analysis and narrative synthesis.

Results Only a minority of reported CPA was brought to the attention of professionals and the most prominent barrier to disclosure was lack of trust in adults or authorities. The police-reported cases of suspected CPA were characterised by high severity, but only a small proportion of the 158 alleged child victims were physically examined and only half were forensically interviewed. All 88 responding physicians in 22 European countries described multidisciplinary involvement in the management of suspected child maltreatment, but wide variations in the organisational approaches were revealed. A sustained decline in childhood deaths from external causes during a 15-year period was observed. A sizeable number of infant deaths were recorded each year as ill-defined or with incomplete documentation from clinicians.

Conclusions The results presented in this thesis suggest that the multi-sector response in Sweden and in Europe is insufficiently organised, with no clear mandate for the health sector to robustly combat child maltreatment, and that this may undermine the ability of society to adequately protect children.